"Family therapy gives you a language to talk about things; a safe place to air differences," said a parent of a bulimic daughter.

Standard bulimia nervosa treatments include medications (prescription drugs), various psychotherapies, nutrition therapy, other non-drug therapies and supportive or adjunct interventions such as yoga, art, massage, and movement therapy. Some novel treatments are currently under research, such as implantation of a device called a vagus nerve stimulator implanted at the base of the neck. This stimulator is currently in use to treat some forms of depression, and it is under research for treating obesity.

The most commonly used treatmentspsychotherapy and medicationare delivered at various levels of inpatient and outpatient care, and in various settings depending on the severity of the illness and the treatment plan that has been developed for a particular patient. Bulimia nervosa can often be treated on an outpatient basis, although more severe cases may require inpatient residential treatment. The levels of care and types of treatment centers are discussed in a separate section of this guide. The treatment plan should be developed by a multidisciplinary team in consultation with the patient, and family members as deemed appropriate by the patient and his or her team.

Types of prescription drug therapy

Biochemical abnormalities in the brain and body have been associated with bulimia nervosa. Many types of prescription drugs have been used in treatment of bulimia nervosa, however, only one prescription drug (fluoxetine) actually has a labeled indication for bulimia nervosa. (This means that the manufacturer requested the U.S. Food and Drug Administration for permission to market the drug specifically for treatment of bulimia nervosa, and that FDA approved this request based on the evidence the manufacturer provided about the drug's efficacy for bulimia nervosa.)

Anti-depressants are intended to try to reduce a patient's urge to binge and purge by treating depression, anxiety, and OCD. Generic and brand names of prescription drugs that have been used to treat bulimia nervosa are listed in the chart. Some of these anti-depressants also can exert other effects. SSRIs alleviate depression but may also play a role in making an individual feel full and possibly prevent binge eating.

Antidepressants

Tricyclics

Amitriptyline (Elavil)

Clomipramine (Anafranil)

Desipramine (Norpramin, Pertofrane)

Imipramine (Janimine, Tofranil)

Nortriptyline (Aventyl, Pamelor)

Selective serotonin reuptake inhibitors (SSRIs)

Citalopram (Celexa)

Escitalopram (Lexapro)

Fluoxetine (Prozac, Sarafem)

Fluvoxamine (Luvox)

Paroxetine (Paxil)

Sertraline (Zoloft)

Monoamine oxidase inhibitors

Brofaromine (Consonar)

Isocarboxazide (Benazide)

Moclobemide (Manerix)

Phenelzine (Nardil)

Tranylcipromine (Parnate)

Tetracyclics

Mianserin (Bolvidon)

Mirtazapine (Remeron)

Modified cyclic antidepressants

Trazodone (Desyrel)

Aminoketonea

Bupropion (Zyban) (This drug was once used, but is now contraindicated for treatment of eating disorders because of several reports of drug-related seizures.)

Phenethylamine monoamine reuptake inhibitor

Venlafaxine (Effexor)

Serotonin and noradrenaline reuptake inhibitor

Duloxetine (Cymbalta)

Opioid antagonist

Naltrexone (Nalorex) (Intended to alleviate addictive behaviors such as the addictive drive to eat or binge eat.)

Antiemetic

Ondansetron (Zofran) (Used to give sensation of satiety and fullness.)

Several types of psychotherapy are used in individual and group settings and with families. A given psychologist may use several different approaches tailored to the situation. The types of psychotherapy used are listed here in a chart and defined in the glossary. Cognitive behavior therapy (CBT) and behavior therapy (BT) have been used for many years as first-line treatment and are the most-used types of psychotherapy for this disorder.

CBT involves three overlapping phases. The first phase focuses on helping people to resist the urge to engage in the cycle of behavior by educating them about the dangers. The second phase introduces procedures to reduce dietary restraint and increase the regularity of eating. The last phase involves teaching people relapse-prevention strategies to help prepare them for possible setbacks. A course of individual CBT for bulimia nervosa usually involves 16 to 20 hour-long sessions over 4 to 5 months. BT uses principles of learning to increase the frequency of desired behavior and decrease the frequency of problem behavior. When used to treat bulimia nervosa, BT focuses on teaching relaxation techniques and coping strategies that individuals can use instead of binge eating and purging or excessive exercise or fasting.

Self-help groups are listed here because they may be the only option available to people who have no insurance. However, self-help groups can also have negative affects on a person with an eating disorder if they are not well-moderated by a trained professional.

Family therapy

Involving family members in psychotherapy sessions with and without the patient

Group psychotherapy

Cognitive behavioral therapy

Psychodynamic

Psychoeducational

Self-help groups

ANAD (Anorexia Nervosa and Associated Disorders)

12-step approaches

Eating disorders anonymous

Other types of treatment

Many interventions that do not involve prescription drugs or psychotherapy have been used as adjuncts or supportive therapy. Some people consider some of these options to be "alternative or complementary therapy." Opinions differ about the role of many of these therapies in treatment. The approach we have taken in this guide is to identify all the treatments and interventions used with bulimia nervosa patients and then search for clinical trials that evaluated these treatments to see if there is any evidence of how well they work. The results of our searches found that few or no well-conducted clinical studies have been done on these adjunct or alternative interventions for bulimia nervosa, so no one really knows whether or not they work or help patients.

Some of these interventions are used alone; others are used in conjunction with medications or psychotherapy. Some may be included as activities made available at residential treatment centers; others may be used in private therapists' offices. Because these treatments are available and may be offered to patients, even though their effectiveness is unknown, we list them here. They are defined in the glossary.

Bulimia nervosa is an eating disorder in which a person engages in binge eating (eating a lot of food in a short time) followed by some type of behavior to prevent weight gain from the food that was eaten. This behavior can take two forms: self-induced vomiting, misuse of enemas, laxatives, diet pills (called purging) and excessive exercise, fasting, or diabetic omission of insulin (called non-purging). Some people with bulimia nervosa may also starve themselves for periods of time before binge eating again. Bulimia nervosa has important mental, emotional, and physical aspects that require consideration during treatment.